NickelChip

Yeah, while I work for myself so don't have to deal with coverage or time-off approval, I was somewhat grateful February was the option the doctor gave me. I had already rearranged a lot to accommodate the December date, and when that fell through, it left me scrambling. Turns out the week in February they gave me is pretty ideal, so I'm glad about that, even if the countdown is killing me. Between now and then, my main focus is on getting back to healthy foods after the holidays and developing a better schedule for meals and exercise that will help me be a bit more regular about both.

As long as the higher fat in the cheese doesn't make you feel sick, I would personally rather have a small piece of real cheese than a bigger piece of low-fat or fat-free "cheese". I can handle low-fat or fat-free milk, cottage cheese, yogurt, etc. But cheese is sacred. There's a traditional cheese factory in Vermont, about 2 hours from where I live, with the most amazing cheese I have ever tasted. Right now, I can probably eat a pound of it all on my own over the course of a weekend. I shouldn't. I know this. But I could, so I don't buy it. But after surgery, I think I will. Who cares if it costs $35 a pound if I can only eat maybe an ounce? Go to a local cheesemaker if you have one and buy a really small amount of the most insanely expensive, insanely delicious cheese you can find. That's my advice. If it comes wrapped in plastic, don't bother. You can do better.

I am preop and was just reading through the folder my surgeon's office has given me. There's a section called keeping the weight off where they talk about portions after you've gotten past the honeymoon period. They say that a meal should be 3-4 oz of lean protein with 20-25g protein, 1/2 cup of whole grain or starchy vegetables, and then half of the plate is leafy/non-starchy veg and fruit. The most important part for me was where they said: Sometimes portion sizes increase over time. If you feel you are able to eat more at meals, increase the portion of non-starchy vegetables. I would start there, because I think the tendency as appetite increases is to grab a bigger plate and increase everything proportionally. So now you may be eating 5-6 oz protein and 3/4 to 1 cup of starch or grain. And maybe adding in more sauces, more fats, a piece of bread, some alcohol, juice, some sweet treats, a daily snack. My surgeon's plan emphasizes keeping to 3 meals per day without snacking once you're past the first few weeks where you need to supplement with protein shakes just to meet minimum protein goals. But if you can regularly get 20-25g protein at a meal, plus 1/2 cup starch or grain and some veg/fruit, you don't need to eat more than 3 times per day, 4-6 hours apart. This is something that isn't always made clear. When I started this journey, I was certain that gastric bypass would mean having to eat lots of small meals all throughout the day, which is exactly what I'm being told not to do! But you do need to get at least 64oz of water or more all the time, and you can add as much veg and fruit as you need to feel full. I think that is where I would start in your position. Go back to measuring your meals, setting timers to remind you when your meal times are if you need to, eating only food you prepare yourself and/or know exactly what's in it. Check your cupboards for temptations and get rid of them. Pay attention to the urges you have to do something that isn't part of your plan, because that's probably going to show you the problem areas and help you figure out how to change. And most of all, give yourself a little bit of grace, because this isn't easy (no matter what people try to say). Take care of yourself. Get enough sleep. Get fresh air and exercise. Be kind to yourself.

Did you know there is a limit to how many vials of blood they can take on a single day at the hospital? Apparently, the limit is 12. Despite combining a few of the 17 different tests ordered by my surgeon, there are still 4 tests remaining that I will have to go back for another time. The phlebotomist just kept shaking her head and wondering out loud what all these doctors are thinking when they order so many tests all at once. Fortunately, it's not a rush. I told the surgeon what had happened and he said I could wait to do the others until the end of the month when I'm back in town for a final meeting with the dietician. (It's about 45-60 minutes without traffic from my house to the hospital.) The barium swallow test lived up to its reputation. Thick grey sludge in a cup. Yuck. But I got to see my heart beating on the video screen, so that was trippy. And the technicians were very funny, so I was kept entertained. The results came back saying I have a minuscule hiatal hernia. Not sure if it will require any fixing. My EKG was normal, but had I realized they would be putting sensors on my legs, too, I would have shaved!

This could be my personal life motto.

I love how supportive you have been of your wife (and am sorry to hear her diabetes remains an issue). I honestly think the relationships that most often fail post-surgery are the ones that are not healthy to begin with. The effects of the weight loss just shine a light on the problems that were already there and being ignored. Society sends the message that being overweight equals being unattractive, that you'll never find a partner unless you're slim, or that you're darn lucky if you do have someone, even if that person treats you poorly, and you'd better put up with it because you won't get anything better. None of that is actually true, of course, but sometimes losing weight is the thing that makes a person realize it and start believing they deserve a happy life. But if a spouse is one of the "good ones," they'll take your advice to heart and end up with an even better relationship. I'm so glad that's what has happened to you and your wife!

Mine is scheduled for February 21! (It was supposed to be December 27, but that was a whole big mess detailed in another post). I met my new surgeon on Tuesday and had my blood work, EKG, and barium swallow yesterday. 7 weeks to go!

So glad you're here! There is so much idiocy in the medical community regarding weight and weight loss. Doctors literally know 95% of people cannot physically lose more than a small amount of their weight and keep it off, but they act like everyone can except you and they can't figure out why you're not doing it. Imagine if they told diabetics they couldn't have insulin until they used their willpower to lower their blood sugar on their own, just to prove they take it seriously. As for your ex partner, I hope on your behalf that certain parts of his anatomy shrivel up and fall off. You deserve better, no matter what weight you are at. It's hard not to internalize that kind of abuse, but remind yourself as often as you need to that he's garbage and did you a favor by taking himself out.

One thing about mental hunger or cravings is that they're almost never strong enough for me to actually get into a car and drive to a store to buy something. The first few weeks, I would end up digging until I found something else to eat, but the fewer options you make available, the more you have to admit to yourself that you're just bored or (as is often my case since I work from home) procrastinating. There have been times I would find myself staring into my pantry and I'd have to ask myself what exactly I thought I would find there. It's all canned beans and pasta sauce now. Generally I just ask myself if I want a snack badly enough to drive to the store for it, and the answer is always no. Oh, and I do all my grocery shopping online for pickup now to minimize the chances of throwing impulse buys into my cart.

With about 5 months ahead of you, I suggest making some changes to your eating now to break yourself of bad habits and get into better ones. For example, I started this journey in July and spent the first month cleaning my cupboards. As I used up unhealthy snack foods, sweets, and processed foods, I opted not to buy more. I replaced the crackers and chips I would snack on with dry roasted, lightly salted nuts. I added a lot of veggies and fruit to my diet every day. The next month, I stopped drinking diet soda and artificial sweeteners and cut way back on sugar. The next month, I stopped buying bread and cut way back on dairy. I bought a few bariatric cookbooks and have been finding recipes to try. I might still have bread, diet soda, dairy, or sweets every so often when I'm out, but I don't keep it in the house, which means I'm avoiding it probably 90% of the time. I also started taking my vitamins so I will be in the habit of taking them every day and not forgetting. Oh, and I got into a good routine with water and trying to remember to take a water bottle with me wherever I go. Changes like that will hopefully go a long way in helping you feel mentally prepared for the changes you have to make post-surgery.

I just got home from my appointment and am happy to say that I'm now scheduled for surgery on February 21. I was able to meet with the dietician right after my appointment with the surgeon and she went over the differences between my old program and their protocols, which are similar with the exception that I will need to do the 2-week liquid diet (my old place only did 2 days). I head to the hospital tomorrow for pretests and then just have to wait the 7 weeks until surgery. Time to get back to my good eating habits after the holidays! I thought everyone was very nice and I got a lot of sympathy for what I'd gone through with the center closing. I was told one patient who is now at the new practice actually arrived at the hospital the day of her surgery and only then found out it had been cancelled. No one even called her. I don't even know what I would have done had that happened.

I can't imagine why a single cocktail a few weeks before surgery would be an issue when you haven't been given any kind of pre-op restrictions. Seems like the right time for one final toast to the future.

If it helps, remember that this is a completely different surgery than years ago. The reason the risk used to be so much higher was they had to cut you open, exposing you to all sorts of infection risks along with making it really traumatic for your body. Nowadays, they make tiny incisions and even use robotic assistance in some cases. The death rate for bypass is less than 1 in a thousand, and the sleeve is even less than that. Any other statistics are ancient history. It would be like comparing outcomes for diseases today to a time before we had antibiotics, chemotherapy, or insulin.

I highly recommend looking at the videos on the Pound of Cure channel on You Tube, which go into detail about how to eat to lower your body's metabolic setpoint. Foods that are ultra-processed and high carb push your body's setpoint, the weight it wants to maintain, higher, where nutrient dense foods like leafy green vegetables, beans, nuts, and seeds, make your body want to maintain a lower weight. As I have been preparing for surgery, I found the Pound of Cure book on Amazon and implemented many of the basic changes it recommends, such as cutting out processed foods, breads, sugar, and artificial sweeteners, and eating more vegetables, fruits, and beans. I lost 15 pounds in around 3 months without counting calories or ever feeling hungry. And I can also say that in the past several weeks, as the holiday treats have infiltrated my house, I have not been as good about eating that way, and to no one's surprise, my weight has shifted upward. I will be returning to better nutrition as soon as the last of the ham, sweet potatoes, and pie from Christmas dinner is out of the house! I recommend starting with these videos that I've linked below (and then, if you're like me, binge watching the rest of Dr. Weiner's channel). I find his advice to be a common sense approach to nutrition that you should be able to implement long-term without a lot of pain. Hope this helps!

The reason for erratic weigh-ins (and the infamous three-week stall) is that in the early stages of running a sustained calorie deficit, your body does not burn much fat. Your body worked hard to store fat and considers it a precious commodity that it does not want to part with for no reason. For extra energy to make up for a lack of calories in the short term, your body first burns glycogen. 1 gram of glycogen is bound with 3 grams of water, so as you burn it for fuel, you also flush out this water weight. Only when the glycogen reserve is used up does your body turn to burning fat. The first few weeks after surgery, you were probably lucky to get in 600 calories per day. Your body was burning glycogen like crazy. When the numbers first dropped on the scale, that was almost entirely water weight. Now that you're a couple weeks out, you're allowed to have some pureed food, and you can probably get closer to your protein goals with your shakes. With a few extra calories coming in (still nowhere close to what you need every day to power your bodily functions), your body is at least reassured you are not in imminent danger of starvation. It's taking a look at your empty glycogen reserves with horror and doing its best to fill them back up with the calories you are giving it, like a squirrel storing up acorns for winter. For every gram of glycogen your body puts into the storage cupboard, you've got 3 grams of water tagging along for the ride. Meanwhile, you can rest assured that your body is also burning fat to keep your engines running. However, when you step on the scale, it can't really tell you that you've burned 4 pounds of fat and also stored 7 pounds of glycogen and water. It's just going to tell you that you've gained 3 pounds. But you've done nothing wrong. This is your body doing what evolution programmed it to do since humans lived in caves and constantly had to battle short-term food shortages. Once you've restocked that glycogen, you'll start being able to see the fat loss on the scale again, and in your measurements. As long as you keep doing what you're supposed to do, your weight will move in the right direction. But not as a straight line. Weight loss looks a lot more like a staircase with drops and plateaus, and a lot of small fluctuations that have nothing to do with fat. Try not to let it drive you crazy!

The instructions I was given were 48 hours of pre-op liquid, with total fasting beginning the evening before surgery. The longer liquid diet is to promote rapid weight-loss and shrink your liver, but some surgeons don't find this necessary, or only apply it to patients over a certain BMI. The 24-48 hours of liquid-only and/or fasting prior to surgery is just to clear your digestive tract prior to operating. Also, some surgeons don't require a puree stage and go from foods like yogurt and ricotta directly to moist proteins and fully cooked veg that you are instructed to chew for 30 seconds to a minute before swallowing (essentially pureeing them with your teeth).

I would be very hesitant to get the sleeve, to be honest, in your case. If at all possible, I suggest shopping around for a different surgeon, one who feels confident performing the surgery that you want. In the long run, it would be worth a delay to avoid a nightmare.

I mean, I guess fear of prison is ultimately what keeps me from actually slapping stupid people... but the way the world is going, something's bound to make me break eventually. Honestly, why is it so hard for people to just be supportive and kind to other people?

The biggest thing that has helped me with being better (not perfect!) about foods was getting all of the temptations out of my house. I went through every cupboard. When crackers or chips were gone, I did not buy more. I've also started ordering my groceries for curbside pickup. I hadn't realized what a huge help this was until this morning when I had to run in for a few things last minute. It was all I could do to walk past the bakery without buying a loaf of fresh sourdough or to keep myself from throwing a bag of Christmas candy into the cart. Shopping online from a carefully curated list is so much less dangerous! At least for me, removing the opportunity to easily access snacks makes a big difference.

I'm not sure how many months out from surgery you are, but it sounds like the goal you set and the weight your body wants to be right now are at odds. Are you dangerously underweight at this point, or experiencing other serious negative side effects from losing weight? If not, I would suggest riding it out. Continue to eat nutrient dense foods in reasonable portions to the point of feeling satisfied from them, get a healthy amount of exercise, and ignore the numbers on the scale or the reflection in the mirror for a while until your body has a chance to figure itself out on its own time. I think most of the time, it sorts itself out. When my brother had his VSG 15 years ago, he had a period of several months, maybe 12-18 months after his surgery, where he was very skinny, to the point of him being a little concerned (and self-conscious about it since he was used to being a big guy). And then it all kind of fell into place without him having to do anything drastic.

Do your research, make the decision that is right for you, and tell them they can either support you or not, but that your medical decisions are yours alone to make in consultation with your doctor. End of discussion. I suggest you speak about it in declarative sentences. Don't say, "I'm thinking about having surgery, so what are your thoughts about that?" Instead, say, "I will be having surgery in x number of months, and if you have questions or concerns about this, I am happy to have you talk with my doctor about why this is the right choice for me and how you can support me on this journey." You are the only person who lives in your body. That makes you the only person who gets to decide how best to take care of it. Your mother and partner are basing their opinions on incorrect information, emotions, and horror stories. You can try to give them the correct information, but don't let their fears sway you. As was mentioned above, it is probably more about the fear of change than anything else.

I've personally been on both Saxenda and Wegovy. With Saxenda, I lost 20 pounds and my blood sugar and cholesterol improved, but high blood pressure was unchanged. I stopped because the insurance price went from $50 a month to over $200, and my weight loss plateaued so $2400 a year to keep off 20 lbs seemed a bit steep. As soon as I stopped, the weight came back, the A1Cs went up, and the cholesterol went higher than before I started. With Wegovy, I was only ever able to get the first two months of doses before shortages made it impossible. After that, I switched insurance and lost coverage of Wegovy completely, meaning over $1k per month out of pocket if I wanted to continue. I wasn't on it long enough to see how my labs would have been. From everything I've seen, surgery is the only durable option. In my case, the copay is less than a single month of Wegovy, with the possibility of it lasting a lifetime, and the ability to add the GLP-1 drugs down the road if needed. Only you can decide what is right for you, but I think for most people who are at the point of qualifying for surgery, the drugs alone will not be enough, and if you lose access to them, you will most likely go back to square one with weight. Or in my case, square one plus 10 pounds.

Love this new podcast! Dr. Weiner is one of my favorite sources of information.

Even with all the bandages you look tiny! I hope your recovery goes well. It sounds like you're getting great care.

The most likely way I can think to lose 8 lbs in 18 days would be to stick with a very low calorie diet of protein shakes and steamed or raw vegetables from now until after your appointment. Not the easiest thing to do with the holidays, and not a very healthy way of eating, though.